Northwest Community EMS System November 2018 CE: Cardiac Treatment Credit Questions

Transcription

1 Northwest Community EMS System November 2018 CE: Cardiac Treatment Credit Questions Name: EMS Agency/hospital: EMSC/Educator reviewer: Date submitted: Credit awarded (date): Returned for revisions: Revisions received: This packet should take 2 hours to complete which earns you the equivalent of the 2 hour live CE class. Sources: November CE slide deck; SOPs: NWC EMSS Website. If you should have any questions, please feel free to Contact Susan Wood, RN, Paramedic at swood@nch.org

2 NWC EMSS CE Credit Questions Page 2 NWC EMSS November 2018 CE CQ Cardiac Treatment 1. What SOP will most often be used in coordination with others (bradycardia, narrow or wide complex tachycardia) when treating an acutely ill cardiac patient? 2. Patients with cardiac symptoms often delay seeking medical care; what 7 reasons do people delay in seeking treatment according to the pp? 3. What 4 ways has medicine improved overall mortality for patients? 4. When a person has an acute episode of pain, what is their body trying to tell them? 5. What 3 types of patients have more often atypical presentations than the general population? 6. What 7 goals are found in the management of EMS for patients with cardiac abnormalities?

3 NWC EMSS CE Credit Questions Page 3 7. A 70 y/o male began to experience chest pain rated 9/10 while getting dressed. He is awake answering questions appropriately. VS: BP: 96/60; P: 36; ECG: as below; RR 18; SpO 2 93%; lungs: clear; glucose: 120; Skin is warm and dry. Weight: 190 lbs. Is this patient a candidate for ASA? NTG? Fentanyl? 8. What 6 factors help to determine acuity for a patient with bradycardia with a pulse? 9. Identify 4 possible etiologies that should be assessed for as underlying causes of symptomatic bradycardia? 10. EMS responds for weakness & lightheadedness. Found is a 68 y/o F on the in front yard raking leaves. It is noticed that there are 8 huge bags collected & she states she has been working all day. Her neighbor came out to check on her when she began to feel faint. She did not fall or lose consciousness. It is a sunny, 66 day. Pt is pale, cool & moist. Answers questions appropriately, but eyes remain closed; c/o dizziness. Breathing unlabored denies CP, SOB, or N/V. Meds: ASA 81 mg, losartan, metformin & glyburide. NKDA. PMH: HTN. Her radial pulse is very weak and very slow. Lungs are clear. *Pt gives h/o recently adjusted meds at MDs office. VS: BP 88/60, HR 40, RR 18, SpO2 on RA 95%, ETCO2 is 32. What three things are of greatest concern as you evaluate this pts condition? 11. What is the next priority for assessment after obtaining a 4 lead ECG?

4 NWC EMSS CE Credit Questions Page When a pt has symptomatic bradycardia with hypotension, which is the priority to address first in order of care? 13. What 3 priorities for care should be given to a symptomatic bradycardic patient? 14. Which 2 blocks will atropine most likely work to effect on pts with symptomatic bradycardia? 15. Why would atropine prove ineffective in treating a patient with a transplanted heart? 16. Atropine for bradycardia: Dose? Frequency? Max? 17. What is the second drug indicated for symptomatic bradycardia if atropine is either ineffective or contraindicated? 18. What classification of drug is norepinephrine and what is main effect does it have towards the body? 19. True or false: norepinephrine along with all other EMS drugs are allowed to be mainlined into the patient s vasculature system in our EMS system. 20. Identify all equipment needed when initiating an infusion of norepinephrine. 21. An elderly adult presents w/ confusion, weakness & syncope. VS: BP 82/58; P 40, ECG: below; R 20, SpO2 90%; lungs clear; glucose 110. Skin pale & moist. Wt 190 lbs. What intervention is indicated first for the above patient? A. Atropine 1 mg rapid IVP B. Begin pacing at 60 BPM C. Place TCP pads; don t pace yet D. Norepinephrine drip at 8mcg/min

5 NWC EMSS CE Credit Questions Page Identify the steps required when initiating pacing a patient using your current monitor. 23. How can a PM identify that the pacing of the patient was successful? 24. What can the patient being paced be treated with if they become agitated provided their SBP is above 90 mmhg? What can the patient being paced be treated with for pain management provided their SBP is above 90 mmhg? 25. What are common underlying causes should be assessed when encountering a patient with symptomatic tachycardia including physiologic stimuli? EMS is dispatched for a 28 y/o F w/ chest pounding & heaviness. Pt found at work where she suddenly didn t feel well & needed to sit down. Pt is A x O X 3. Speaks in full sentences & breathing appears unlabored. Skin is diaphoretic but warm. You attempt to count a radial pulse but it is too fast. Lungs clear. Pt is put on the monitor: 26. What is your interpretation? BP 100/66, HR 210, RR 18, SpO2 96%, ETCO2 34. Rates discomfort as 6/10. Co-worker states pt has problem with her heart racing every so often.

6 NWC EMSS CE Credit Questions Page Which of these is indicated first for a stable pt in the above rhythm (HR 190) to slow the rhythm? A. Verapamil B. Adenocard C. Cardioversion D. Vagal maneuvers 28. When performing a vagal maneuver, what is the ideal and most effective way in which it should be accomplished? 29. If the pt in Q 26 does not respond to the initial treatment, what should be the next option for care? After the above treatment, reassessment includes: VS: BP 94/60, HR 172, RR 12, SpO2 93%, ETCO2 32, square. 30. What action is indicated? VS: BP 84/60, HR 172, RR 22, SpO2 90%, ETCO2 32, square. 31. What action is indicated? 32. An adult is c/o chest pain and palpitations. Pulse too fast to count. BP 110/74; R 16; SpO 2 95%. ECG Hint: look very carefully at the baseline. 33. After Vagal maneuvers, what intervention is indicated? A. Verapamil 5 mg IVP B. Adenocard 6 mg IVP C. Magnesium 2 Gm IVP D. Amiodarone 150 mg IVP 34. True or false: When attempting to characterize the baseline of atrial flutter, it is fair to say that the baseline is more vertical than horizontal. 35. What is the treatment per SOP used in order to slow atrial ectopic activity? 36. What should be given for procedural sedation prior to cardioversion if pt is conscious and BP is OK? A. Fentanyl B. Etomidate C. Midazolam D. Nitrous oxide

7 NWC EMSS CE Credit Questions Page When treating a patient with wide complex tachycardia, what is the one assessment finding that must be confirmed prior to proceeding with medical care? 38. Which intervention is indicated per SOP for a stable patient with the rhythm noted below? A. Lidocaine 1.5 mg/kg B. Magnesium 2 Gm in 16 ml NS C. Amiodarone 150 mg mixed w/ 7 ml NS D. Synchronized cardioversion at 100 J 39. If a patient responds to the above treatment before the administration of the full dose is completed, should the infusion be stopped or continued until completion? 40. What intervention is indicated first for a stable patient with the rhythm noted below? A. Amiodarone B. Magnesium C. Defibrillation D. Synchronized cardioversion These questions complete the makeup materials for November s CE.